Abstracts from 2020 national congress of the Italian Society of Hypertension (SIIA)
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ABSTRACTS
Abstracts from 2020 national congress of the Italian Society of Hypertension (SIIA)
Ó Italian Society of Hypertension 2020
Metabolic Aspects and Associated Risk Factors
SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS (SGLT2I) ARE ‘‘HYBRID’’ DIURETICS THAT PROTECT FROM TARGET ORGAN DAMAGE AND CARDIOVASCULAR EVENTS: A NEW ‘‘WEAPON’’ FOR INTERNISTS AND CARDIOLOGISTS Francesco Spannella1,2, Federico Giulietti1,2, Chiara Di Pentima1, Riccardo Sarzani1,2 1) Department of Clinical and Molecular Sciences, University ‘‘Politecnica delle Marche’’,Ancona, Italy; 2) Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy INTRODUCTION: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) act on the proximal renal tubule and have been found to exert relevant cardiovascular benefits beyond the mere glycemic control in patients with diabetes. Their use have been associated to a reduction in both target organ damage and cardiovascular events, mainly heart failure and progression of renal disease. METHODS: We performed an extensive review of the available literature aiming at describing the main pathophysiological mechanisms of SGLT2i that may have led to such positive findings in the randomized clinical trials performed with this drug class. RESULTS: These ‘‘antidiabetic’’ drugs act as ‘‘hybrid’’ diuretics. Indeed, they promote both natriuresis and osmotic diuresis due to glycosuria, leading to a reduction in blood volume and blood pressure. This peculiar activity, not found in the other classic diuretics, is mainly derived by the stimulation of the renal tubuleglomerular feedback, leading to the release of adenosine by macula densa cells, resulting in a vasoconstriction of the afferent arteriole and a reduction of renin release. These mechanisms lead to lower intraglomerular
pressure, preventing the hyperfiltration-mediated organ damage tipically found in diabetes, hypertension and obesity. In the CREDENCE trial, Canagliflozin led to a 30% reduction in both the progression of renal disease and cardiovascular deaths in patients with diabetes (but no renal disease) who were also taking renin-angiotensin-system inhibitors. Natriuresis and glycosuria lead to lower circulating blood volume and pressure, resulting in lower cardiac overload. Indeed, SGLT2i have been found to reduce both hospitalizations and cardiovascular deaths in patients with heart failure, regardless the diabetic condition, also improving both symptoms and cardiac remodeling. CONCLUSIONS: The beneficial effects of SGLT2i, supported by multiple clinical data, suggest a more extensive use of these drugs also by internists, cardiologists and nefrologists.
THE ASSOCIATION BETWEEN HYPERURICEMIA AND ARTERIAL STIFFNESS AND COGNITIVE IMPAIRMENT IS STILL CONFIRMED AT NORMAL-HIGH VALUES P. Nazzaro, A. Nardecchia, M. Contini, G. Schirosi, L. De Benedittis, G. Aceto, A.M. Papagni Dept of Neurosciences, Unit of Hypertension ‘‘AM. Pirrelli’’, ‘‘Aldo Moro’’ University of Bari, Italy INTRODUCTION: Hyperuricemia (HSUA [ 6 mg/dl) is associated to increased arterial stiffn
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